A clinic based survey of blindness and eye disease in Cambodia
Aims: To survey the spectrum of eye disease presenting to rural eye clinics in Cambodia.
Methods: A total of 1381 patients seen consecutively at 13 eye clinics were examined and the findings recorded.
Results: 231 (16.7%) were bilaterally blind (visual acuity <3/60 in both eyes); 263 (19%) were unilaterally blind, and 169 (12%) had low vision (visual acuity <6/18 in the better eye). Cataract was the commonest cause of visual loss in all three categories and was responsible respectively in 69%, 40% and 55% of each group. Trachoma was diagnosed in 13% of patients. Thirty-three of them needed lid surgery for trichiasis.
Conclusion: With the difficult practical and political situation in Cambodia there seems little prospect of making substantial inroads into the backlog of avoidable blindness in the near future.
Published courtesy of: Br J Ophthalmol 1997; 81: 578-80.
Risk of ocular hyper-tension or open-angle glaucoma in elderly patients on oral glucocorticoids
Edeltraut Garbe, Jacques LeLorier, Jean-Francois Boivin, Samy Suissa
Background: Ocular hypertension and open-angle glaucoma are well-known side-effects of treatment with topical ophthalmic glucocorticoids. There is uncertainty about the risk of these disorders with oral glucocorticoid therapy.
Methods: Data from the Quebec universal health insurance programme for the elderly were used to identify 9793 patients with a new diagnosis of ocular hypertension or open-angle glaucoma, or on newly prescribed treatment for these disorders (cases). 38,325 controls were randomly selected from ophthalmology patients seen in the same month and year as the case (index date). Current use of oral glucocorticoids were defined as that within 14 days of the index date. All glucocorticoid doses were converted to the equivalent amount of hydrocortisone. The case-control analysis was done by conditional logistic regression and adjusted for age, sex, systemic hypertension, diabetes mellitus, ophthalmic glucocorticoids, glucocorticoid injections, and variables related to general health.
Findings: The mean ages of cases and controls were similar (74.9 [SD 6.3] vs 74.7 [6.4]). The adjusted odds ratio of ocular hypertension or open-angle glaucoma for current users of oral glucocorticoids compared with non-users was 1.41 (95% CI 1:22-1.63). There was a dose-related increase in the adjusted odds ratios for current users: 1.26 (1.01-1.56 for less than 40 mg per day of hydrocortisone, 1.37 (1.06-1.76) for patients on 40-79 mg per day, and 1.88 (1.40-2.53) for patients on 80 mg or more per day. The odds ratios also increased with the duration of treatment over the first 11 months of exposure.
Interpretation: The use of oral glucocorticoids increases the risk of ocular hypertension or open-angle glaucoma in elderly patients. In patients in this age-group who need long-term treatment with high doses of oral glucocorticoids, monitoring of intraocular pressure may be justified.
Published courtesy of: Lancet 1997; 350: 979-82
The importance of prenatal factors in childhood blindness in India
J S Rahi FRCOphth, S Sripathi BSc, C E Gilbert FRCOphth, A Foster FRCOphthThe causes of visual loss in 1411 children attending schools for the blind in different geographical areas in India are described. Ninety-three percent (1318) of the children were severely visually impaired (SVI) or blind (i.e., corrected acuity in the better eye of <20/200 [<6/60]). In 60% of SVI/blind children vision loss was attributable to factors operating in the prenatal period, in 47% the prenatal factors were known and definite, and in 13% prenatal factors were the most probable causes. Hereditary retinal dystrophies and albinism were seen in 19% of SVI/blind children and 23% had congenital ocular anomalies. There were variations in the relative importance of different causes by state. The observed pattern of causes of visual loss is intermediate between those seen in industrialised countries and in the poorest developing countries. This suggests that strategies to combat childhood blindness in India need to address concurrently, both preventable and treatable causes. The need for aetiological studies, particularly on anophthalmos and microphthalmos, is highlighted.
Published courtesy of: Dev Med Child Neurol 1997; 39: 449-55.
News and notices in Comm Eye Health Vol. 11 No. 25 1998 –
- High quality low cost intraocular lenses (IOLs)
- A textbook of clinical ophthalmology. A practical guide to disorders of the eyes and their management (2nd edition)
- Standard List of Medicines, Equipment, Instruments and Optical Supplies
- Indian Supplement to the Journal
- Community eye health courses 1998/9
- New publication available from the International Resource Centre: The epidemiology of eye disease
- Dr Joseph Taylor OBE FRCS FRCOphth
- The Royal College of Ophthalmologists Diploma in Ophthalmology Examination